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Reporting to the Audit Manager, the Charge Audit Coordinator position is responsible for the coordination and facilitation of all activities pertinent to Charge Audits being conducted at Brigham & Women's Hospital, Brigham & Women's Faulkner Hospital, Massachusetts General Hospital, Newton Wellesley Hospital, and North Shore Medical Center (other entities as assigned) in accordance with the PHS Charge Audit Policy and established departmental policies and procedures.
Principal Duties and Responsibilities
Coordinates the scheduling of audits with external Payer Audit Representatives/Payers to initiate the charge audit process.
Oversees the preparation of detailed packages for cases selected by Payer Audit Representatives, including itemized bills and other necessary documents needed to initiate the audit process
Ensures timely requests are made to Health Information Management (HIM) for preparation of third party/charge audits, including patient authorizations, as defined by the PHS Charge Audit Policies
Communicates with Payer Audit Representatives throughout the audit process and performs follow-up as needed
Documents and summarizes findings in a clear, concise, and effective manner to preserve PHS appeal rights and to assist with improvements in the charge capture process
Conducts post audit research to support and defend cited charges by obtaining additional documentation and works directly (via, phone, fax, or secure email) with the Payer Audit Representative to arrive at agreed upon audit outcomes in a timely manner.
Documents the findings and final outcomes of all accounts reviewed by the Payer Audit Representative in the PHS Audit Tracking tool and respective billing system
Communicates areas of identified opportunities for revenue improvement to Revenue Integrity Management team. Opportunities can include results from under billed and/or unbilled services/items based on supporting documentation in the medical record when compared to itemized billed charges, or list of active charge codes for a given cost center.
Identifies ongoing issues with charging, coding, billing system edits and documentation for discussion with Revenue Integrity Staff and recommends corrective actions to prevent future losses.
Maintains internal systems used for tracking and reporting of findings, including but not limited to, PHS Audit Tracking System, patient accounting systems, spreadsheets, databases, to facilitate monthly management reporting
Develops and maintains professional working relationships with internal and external stakeholders to facilitate continuous process improvement as it relates to audit activity and findings
Minimum of 2 years of billing audit experience
Format and content of a medical record and various forms of medical/clinical documentation
Medical Terminology and coding including CPT and HCPCs
State and Federal Regulations concerning the use, disclosure and confidentiality of patient records
Auditing principles and standards as applicable to charge audits
Billing, claim forms and charge capture procedures
Excellent oral and written communication skills.
Effective negotiating skills including the ability to resolve cited charge issues by extracting supportive documentation for dispute resolution/appeals purposes are required.
Team and service oriented.
Ability to interact with all levels of health care personnel and hospital/finance management and build strong working relationships with internal and external customers.
Strong organizational and time management skills.
Ability to work independently in a role that requires flexibility in an environment that is deadline driven.
Ability to identify root cause of issues uncovered in the charge audit process and gather, organize and present issues to appropriate areas with recommendations for corrective actions.
Experience with computer software programs such as Word and Excel are required.
Ability to function as a department subject matter expert and resource with a focus on contributing to the achievement of departmental and corporate goals.
Mass General Brigham is an Equal Opportunity Employer & by embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law.